Healthcare Provider Details

I. General information

NPI: 1871609651
Provider Name (Legal Business Name): JESSICA STASCHAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1527
  • Fax: 215-590-1501
Mailing address:
  • Phone: 215-590-1527
  • Fax: 215-590-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP008191
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: